Skip to main content
Top
Published in: Current Psychiatry Reports 8/2020

Open Access 01-08-2020 | Suicide | Personality Disorders (K Bertsch, Section Editor)

Pharmacotherapy for Borderline Personality Disorder: an Update of Published, Unpublished and Ongoing Studies

Authors: Jutta Stoffers-Winterling, Ole Jakob Storebø, Klaus Lieb

Published in: Current Psychiatry Reports | Issue 8/2020

Login to get access

Abstract

Purpose of the Review

We aim to identify the most recent evidence of randomised controlled trials evaluating continued drug treatments in people with a diagnosis of BPD, review the most recent findings, highlight trends in terms of currently ongoing studies and comment on the overall body of evidence.

Recent Findings

We identified seven new RCTs, plus newly available data for an older RCT. Only three of these RCTs have been published in full text, while we found study data posted at trial registry platforms for the others.

Summary

The new findings do not support fluoxetine as a treatment option for suicide and self-harm prevention. A large effectiveness study did not detect beneficial effects of lamotrigine in routine care. The prevalent use of medications in BPD is still not reflected or supported by the current evidence. More research is needed regarding the most commonly used substances and substance classes, i.e. SSRIs, and quetiapine, but also with respect to people presenting with distinct comorbid conditions.
Literature
3.
go back to reference Stoffers JM, Vollm BA, Rucker G, Timmer A, Huband N, Lieb K. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev [Internet]. 2012; Available from: ://WOS:000308220400007. Stoffers JM, Vollm BA, Rucker G, Timmer A, Huband N, Lieb K. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev [Internet]. 2012; Available from: ://WOS:000308220400007.
5.
go back to reference Oud M, Arntz A, Hermens ML, Verhoef R, Kendall T. Specialized psychotherapies for adults with borderline personality disorder: a systematic review and meta-analysis. Aust N Z J Psychiatry. 2018;4867418791257. Oud M, Arntz A, Hermens ML, Verhoef R, Kendall T. Specialized psychotherapies for adults with borderline personality disorder: a systematic review and meta-analysis. Aust N Z J Psychiatry. 2018;4867418791257.
6.
go back to reference Cristea IA, Gentili C, Cotet CD, Palomba D, Barbui C, Cuijpers P. Efficacy of psychotherapies for borderline personality disorder: a systematic review and meta-analysis. JAMA Psychiatry. 2017;74:319–28.CrossRef Cristea IA, Gentili C, Cotet CD, Palomba D, Barbui C, Cuijpers P. Efficacy of psychotherapies for borderline personality disorder: a systematic review and meta-analysis. JAMA Psychiatry. 2017;74:319–28.CrossRef
8.
go back to reference Bridler R, Haberle A, Muller ST, Cattapan K, Grohmann R, Toto S, et al. Psychopharmacological treatment of 2195 in-patients with borderline personality disorder: a comparison with other psychiatric disorders. Eur Neuropsychopharmacol. 2015;25:763–72.CrossRef Bridler R, Haberle A, Muller ST, Cattapan K, Grohmann R, Toto S, et al. Psychopharmacological treatment of 2195 in-patients with borderline personality disorder: a comparison with other psychiatric disorders. Eur Neuropsychopharmacol. 2015;25:763–72.CrossRef
9.
go back to reference Paris J. Why patients with severe personality disorders are overmedicated. J Clin Psychiatry. 2015;76:e521.CrossRef Paris J. Why patients with severe personality disorders are overmedicated. J Clin Psychiatry. 2015;76:e521.CrossRef
10.
go back to reference Stoffers JM, Lieb K. Pharmacotherapy for borderline personality disorder-current evidence and recent trends. Curr Psychiatry Rep. 2015;17:534.CrossRef Stoffers JM, Lieb K. Pharmacotherapy for borderline personality disorder-current evidence and recent trends. Curr Psychiatry Rep. 2015;17:534.CrossRef
11.
go back to reference • Bozzatello P, Rocca P, Uscinska M, Bellino S. Efficacy and tolerability of asenapine compared with olanzapine in borderline personality disorder: an open-label randomized controlled trial. CNS Drugs. 2017;31:809–19 This RCT compared the two second-generation antipsychotics olanzapine and azenapine but found no clear superiority of any of the substances. Total efficacy of both agents in people with BPD unclear. • Bozzatello P, Rocca P, Uscinska M, Bellino S. Efficacy and tolerability of asenapine compared with olanzapine in borderline personality disorder: an open-label randomized controlled trial. CNS Drugs. 2017;31:809–19 This RCT compared the two second-generation antipsychotics olanzapine and azenapine but found no clear superiority of any of the substances. Total efficacy of both agents in people with BPD unclear.
12.
go back to reference •• Crawford M, Sanatinia R, Barrett B, Cunningham G, Dale O, Ganguli P, et al. The clinical effectiveness and cost-effectiveness of lamotrigine in borderline personality disorder: a randomized placebo-controlled trial. Am J Psychiatry. 2018;175:756–64 A large-scale, pragmatic RCT. No effects were detected in this effectiveness trial. The long observation period of one year and the broad eligibility criteria for participants grant the findings applicable to routine care. •• Crawford M, Sanatinia R, Barrett B, Cunningham G, Dale O, Ganguli P, et al. The clinical effectiveness and cost-effectiveness of lamotrigine in borderline personality disorder: a randomized placebo-controlled trial. Am J Psychiatry. 2018;175:756–64 A large-scale, pragmatic RCT. No effects were detected in this effectiveness trial. The long observation period of one year and the broad eligibility criteria for participants grant the findings applicable to routine care.
13.
go back to reference • Kulkarni J, Thomas N, Hudaib A-R, Gavrilidis E, Grigg J, Tan R, et al. Effect of the glutamate NMDA receptor antagonist Memantine as adjunctive treatment in borderline personality disorder: an exploratory, randomised, double-blind, placebo-controlled trial. CNS Drugs. 2018;32:179–87 Small experiential RCT testing an anti-dementia drug. Authors report higher rate of change of BPD severity by memantine. • Kulkarni J, Thomas N, Hudaib A-R, Gavrilidis E, Grigg J, Tan R, et al. Effect of the glutamate NMDA receptor antagonist Memantine as adjunctive treatment in borderline personality disorder: an exploratory, randomised, double-blind, placebo-controlled trial. CNS Drugs. 2018;32:179–87 Small experiential RCT testing an anti-dementia drug. Authors report higher rate of change of BPD severity by memantine.
14.
go back to reference • Lee SS, Allen J, Black DW, Zanarini MC, Schulz SC. Quetiapine’s effect on the SCL-90-R domains in patients with borderline personality disorder. Ann Clin Psychiatry Off J Am Acad Clin Psychiatry. 2016;28:4–10 Additional data relating to [16]. • Lee SS, Allen J, Black DW, Zanarini MC, Schulz SC. Quetiapine’s effect on the SCL-90-R domains in patients with borderline personality disorder. Ann Clin Psychiatry Off J Am Acad Clin Psychiatry. 2016;28:4–10 Additional data relating to [16].
15.
go back to reference •• Crawford MJ, Sanatinia R, Barrett B, Cunningham G, Dale O, Ganguli P, et al. Lamotrigine for people with borderline personality disorder: a RCT. Health Technol Assess Winch Engl. 2018;22:1–68 Comprehensive study report of [12]. CrossRef •• Crawford MJ, Sanatinia R, Barrett B, Cunningham G, Dale O, Ganguli P, et al. Lamotrigine for people with borderline personality disorder: a RCT. Health Technol Assess Winch Engl. 2018;22:1–68 Comprehensive study report of [12]. CrossRef
16.
go back to reference • Black DW, Zanarini MC, Romine A, Shaw M, Allen J, Schulz SC. Comparison of low and moderate dosages of extended-release quetiapine in borderline personality disorder: a randomized, double-blind, placebo-controlled trial. Am J Psychiatry. 2014;171:1174–82 First and only RCT of quetiapine in people in BPD. New data of this study have been published in [17] and [14]. CrossRef • Black DW, Zanarini MC, Romine A, Shaw M, Allen J, Schulz SC. Comparison of low and moderate dosages of extended-release quetiapine in borderline personality disorder: a randomized, double-blind, placebo-controlled trial. Am J Psychiatry. 2014;171:1174–82 First and only RCT of quetiapine in people in BPD. New data of this study have been published in [17] and [14]. CrossRef
25.
go back to reference Simpson E, Yen S, Costello E, Rosen K, Begin A, Pistorello J, et al. Combined dialectical behavior therapy and fluoxetine in the treatment of borderline personality disorder. J Clin Psychiatry. 2004;65:379–85.CrossRef Simpson E, Yen S, Costello E, Rosen K, Begin A, Pistorello J, et al. Combined dialectical behavior therapy and fluoxetine in the treatment of borderline personality disorder. J Clin Psychiatry. 2004;65:379–85.CrossRef
26.
go back to reference Zanarini MC, Frankenburg FR, Reich DB, Harned AL, Fitzmaurice GM. Rates of psychotropic medication use reported by borderline patients and axis II comparison subjects over 16 years of prospective follow-up. J Clin Psychopharmacol. 2015;35:63–7.CrossRef Zanarini MC, Frankenburg FR, Reich DB, Harned AL, Fitzmaurice GM. Rates of psychotropic medication use reported by borderline patients and axis II comparison subjects over 16 years of prospective follow-up. J Clin Psychopharmacol. 2015;35:63–7.CrossRef
27.
go back to reference Paton C, Crawford MJ, Bhatti SF, Patel MX, Barnes TR. The use of psychotropic medication in patients with emotionally unstable personality disorder under the care of UK mental health services. J Clin Psychiatry. 2015;76:e512–8.CrossRef Paton C, Crawford MJ, Bhatti SF, Patel MX, Barnes TR. The use of psychotropic medication in patients with emotionally unstable personality disorder under the care of UK mental health services. J Clin Psychiatry. 2015;76:e512–8.CrossRef
28.
go back to reference Martin-Blanco A, Ancochea A, Soler J, Elices M, Carmona C, Pascual J. Changes over the last 15 years in the psychopharmacological management of persons with borderline personality disorder. Acta Psychiatr Scand. 2017;136:323–31.CrossRef Martin-Blanco A, Ancochea A, Soler J, Elices M, Carmona C, Pascual J. Changes over the last 15 years in the psychopharmacological management of persons with borderline personality disorder. Acta Psychiatr Scand. 2017;136:323–31.CrossRef
29.
go back to reference Riffer F, Farkas M, Streibl L, Kaiser E, Sprung M. Psychopharmacological treatment of patients with borderline personality disorder: comparing data from routine clinical care with recommended guidelines. Int J Psychiatry Clin Pract. 2019;23:178–88.CrossRef Riffer F, Farkas M, Streibl L, Kaiser E, Sprung M. Psychopharmacological treatment of patients with borderline personality disorder: comparing data from routine clinical care with recommended guidelines. Int J Psychiatry Clin Pract. 2019;23:178–88.CrossRef
30.
go back to reference Ingenhoven T. Pharmacotherapy for borderline patients: business as usual or by default? J Clin Psychiatry. 2015;76:522–3.CrossRef Ingenhoven T. Pharmacotherapy for borderline patients: business as usual or by default? J Clin Psychiatry. 2015;76:522–3.CrossRef
31.
go back to reference Stoffers JM, Völlm BA, Rücker G, Timmer A, Lieb K. Pharmacological interventions for borderline personality disorder. Cochrane Database Syst Rev Online. 2010;6. Stoffers JM, Völlm BA, Rücker G, Timmer A, Lieb K. Pharmacological interventions for borderline personality disorder. Cochrane Database Syst Rev Online. 2010;6.
36.
go back to reference Paolini E, Mezzetti FAF, Pierri F, Moretti P. Pharmacological treatment of borderline personality disorder: a retrospective observational study at inpatient unit in Italy. Int J Psychiatry Clin Pract. 2017;21:75–9.CrossRef Paolini E, Mezzetti FAF, Pierri F, Moretti P. Pharmacological treatment of borderline personality disorder: a retrospective observational study at inpatient unit in Italy. Int J Psychiatry Clin Pract. 2017;21:75–9.CrossRef
38.
go back to reference ISRCTN11135486 - Quetiapine versus sertraline as the pharmacological component in a standardised psychopharmacological and psychotherapeutic treatment of borderline personality disorder: a randomised, rater-blinded study [Internet]. [cited 2014 Jun 13]. Available from: http://www.controlled-trials.com/ISRCTN11135486 ISRCTN11135486 - Quetiapine versus sertraline as the pharmacological component in a standardised psychopharmacological and psychotherapeutic treatment of borderline personality disorder: a randomised, rater-blinded study [Internet]. [cited 2014 Jun 13]. Available from: http://​www.​controlled-trials.​com/​ISRCTN11135486
40.
go back to reference Lieb K, Völlm B, Rücker G, Timmer A, Stoffers JM. Pharmacotherapy for borderline personality disorder: Cochrane systematic review of randomised trials. Br J Psychiatry J Ment Sci. 2010;196:4–12.CrossRef Lieb K, Völlm B, Rücker G, Timmer A, Stoffers JM. Pharmacotherapy for borderline personality disorder: Cochrane systematic review of randomised trials. Br J Psychiatry J Ment Sci. 2010;196:4–12.CrossRef
41.
go back to reference Feurino L, Silk KR. State of the art in the pharmacologic treatment of borderline personality disorder. Curr Psychiatry Rep. 2011;13:69–75.CrossRef Feurino L, Silk KR. State of the art in the pharmacologic treatment of borderline personality disorder. Curr Psychiatry Rep. 2011;13:69–75.CrossRef
42.
go back to reference Abraham PF, Calabrese JR. Evidenced-based pharmacologic treatment of borderline personality disorder: a shift from SSRIs to anticonvulsants and atypical antipsychotics? J Affect Disord. 2008;111:21–30.CrossRef Abraham PF, Calabrese JR. Evidenced-based pharmacologic treatment of borderline personality disorder: a shift from SSRIs to anticonvulsants and atypical antipsychotics? J Affect Disord. 2008;111:21–30.CrossRef
43.
go back to reference Moen R, Freitag M, Miller M, Lee S, Romine A, Song S, et al. Efficacy of extended-release divalproex combined with “condensed” dialectical behavior therapy for individuals with borderline personality disorder. Ann Clin Psychiatry. 2012;24:255–60.PubMed Moen R, Freitag M, Miller M, Lee S, Romine A, Song S, et al. Efficacy of extended-release divalproex combined with “condensed” dialectical behavior therapy for individuals with borderline personality disorder. Ann Clin Psychiatry. 2012;24:255–60.PubMed
44.
go back to reference Hoerst M, Weber-Fahr W, Tunc-Skarka N, Ruf M, Bohus M, Schmahl C, et al. Correlation of glutamate levels in the anterior cingulate cortex with self-reported impulsivity in patients with borderline personality disorder and healthy controls. Arch Gen Psychiatry. 2010;67:946–54.CrossRef Hoerst M, Weber-Fahr W, Tunc-Skarka N, Ruf M, Bohus M, Schmahl C, et al. Correlation of glutamate levels in the anterior cingulate cortex with self-reported impulsivity in patients with borderline personality disorder and healthy controls. Arch Gen Psychiatry. 2010;67:946–54.CrossRef
47.
go back to reference Salzman C, Wolfson AN, Schatzberg A, Looper J, Henke R, Albanese M, et al. Effect of fluoxetine on anger in symptomatic volunteers with borderline personality disorder. J Clin Psychopharmacol. 1995;15:23–9.CrossRef Salzman C, Wolfson AN, Schatzberg A, Looper J, Henke R, Albanese M, et al. Effect of fluoxetine on anger in symptomatic volunteers with borderline personality disorder. J Clin Psychopharmacol. 1995;15:23–9.CrossRef
48.
go back to reference Rinne T, van den Brink W, Wouter L, van Dyck R. SSRI treatment of borderline personality disorder: a randomized, placebo-controlled clinical trial for female patients with borderline personality disorder. Am J Psychiatry. 2002;159:2048–54.CrossRef Rinne T, van den Brink W, Wouter L, van Dyck R. SSRI treatment of borderline personality disorder: a randomized, placebo-controlled clinical trial for female patients with borderline personality disorder. Am J Psychiatry. 2002;159:2048–54.CrossRef
49.
go back to reference Schulz SC, Zanarini MC, Bateman A, Bohus M, Detke HC, Trzaskoma Q, et al. Olanzapine for the treatment of borderline personality disorder: variable dose 12-week randomised double-blind placebo-controlled study. Br J Psychiatry. 2008;193:485–92.CrossRef Schulz SC, Zanarini MC, Bateman A, Bohus M, Detke HC, Trzaskoma Q, et al. Olanzapine for the treatment of borderline personality disorder: variable dose 12-week randomised double-blind placebo-controlled study. Br J Psychiatry. 2008;193:485–92.CrossRef
50.
go back to reference Zanarini MC, Schulz SC, Detke HC, Tanaka Y, Zhao F, Lin D, et al. A dose comparison of olanzapine for the treatment of borderline personality disorder: a 12-week randomized, double-blind, placebo-controlled study. J Clin Psychiatry. 2011;72:1353–62.CrossRef Zanarini MC, Schulz SC, Detke HC, Tanaka Y, Zhao F, Lin D, et al. A dose comparison of olanzapine for the treatment of borderline personality disorder: a 12-week randomized, double-blind, placebo-controlled study. J Clin Psychiatry. 2011;72:1353–62.CrossRef
51.
go back to reference Shah R, Zanarini MC. Comorbidity of borderline personality disorder: current status and future directions. Psychiatry Clin North Am. 2018;41:583–93.CrossRef Shah R, Zanarini MC. Comorbidity of borderline personality disorder: current status and future directions. Psychiatry Clin North Am. 2018;41:583–93.CrossRef
52.
go back to reference Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. Attainment and stability of sustained symptomatic remission and recovery among borderline patients and axis II comparison subjects: a 16-year prospective follow-up study. Am J Psychiatry. 2012;169:476–83.CrossRef Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. Attainment and stability of sustained symptomatic remission and recovery among borderline patients and axis II comparison subjects: a 16-year prospective follow-up study. Am J Psychiatry. 2012;169:476–83.CrossRef
Metadata
Title
Pharmacotherapy for Borderline Personality Disorder: an Update of Published, Unpublished and Ongoing Studies
Authors
Jutta Stoffers-Winterling
Ole Jakob Storebø
Klaus Lieb
Publication date
01-08-2020
Publisher
Springer US
Published in
Current Psychiatry Reports / Issue 8/2020
Print ISSN: 1523-3812
Electronic ISSN: 1535-1645
DOI
https://doi.org/10.1007/s11920-020-01164-1

Other articles of this Issue 8/2020

Current Psychiatry Reports 8/2020 Go to the issue

Child and Family Disaster Psychiatry (B Pfefferbaum, Section Editor)

Children’s Reactions to Media Coverage of War

Sleep Disorders (P Gehrman, Section Editor)

Neuropsychiatric Correlates of Narcolepsy